April 13, 2013

Depression in HCV Often Resolves After Interferon Treatment

Daniel M. Keller, PhD

Apr 11, 2013

NICE, France — Depression affects up to 50% of patients with chronic hepatitis C virus (HCV) infection receiving treatment with interferon, but it appears to be self-limiting and does not usually require antidepressant therapy, new research suggests.

A prospective study conducted by investigators at the Clinic for Psychiatry, Clinical Center of Serbia, in Belgrade showed that severe depression occurred in only a small number of patients and that it spontaneously resolved following completion of HCV therapy with pegylated interferon-alfa and ribavirin (peg-IFN+RBV).

According lead investigator Zorana Pavlović, MD, these findings suggest awareness of depression risk in this patient population but not prophylaxis.

The study was presented here at EPA 2013: 21st European Congress of Psychiatry.

Interdisciplinary Management

According to the investigators, treatment with peg-IFN-α in patients with chronic hepatitis C (CHC) is associated with depression more frequently than in patients with other diseases treated with this drug.

To prospectively estimate the prevalence, severity, and course of depression among HCV patients being treated with peg-IFN+RBV, the investigators compared 103 treated patients (aged 18 - 65 years) with a group of HCV-infected patients not receiving therapy, matching the groups by sociodemographic factors.

A diagnosis of depression was established using the Structured Clinical Interview and criteria of the International Classification of Disorders–10. Severity of depression was assessed with the Hamilton Depression Rating Scale, with a score greater than 7 indicating depression (8 - 16: mild; 17 - 24: moderate; ≥25: severe). Treatment lasted 48 weeks, and the mean dose of peg-IFN was 152.6 ± 25.6 μg.

At baseline, the treatment and control groups did not differ in the mean prevalence of depression, but by week 4, depression was evident among treated patients and persisted through week 48 (all P < .05). The greatest prevalence of depression occurred at week 12 in the treatment group, affecting nearly half the patients to some degree.

Table. Prevalence of Depression With Peg-IFN+RBV Treatment (%)

 

Treatment Week Peg-IFN+RBV Control Patients P-value
0 (baseline) 24.3 21.4 NS*
4 38.8 21.4 < .01
12 49.5 22.3 < .001
24 40.8 22.3 < .01
48 38.8 24.3 < .05
72** 23.3 24.3 NS

* NS = difference not statistically significant

** 24 weeks post-therapy

"Depression spontaneously ameliorated 24 weeks following the completion of peg-interferon-alfa plus ribavirin therapy compared to baseline," Dr. Pavlović reported.

Of treated patients with depression, the majority experienced mild symptoms. At week 12, the point of the highest prevalence of depression, about 28% experienced mild symptoms, and about 22% experienced moderate symptoms.

In the approximately 22% of patients in the control group with symptoms of depression, most of the symptoms were mild. Only a few patients overall had severe depressive symptoms.

Dr. Pavlović strongly recommended an interdisciplinary approach to patients with chronic HCV being treated with peg-IFN+RBV, which would include an infectious disease specialist, a psychiatrist, and a psychologist.

Session chairman Antoine Pelissolo, MD, PhD, professor of psychiatry at Pitié-Salpêtrière Hospital in Paris, France, who was not involved in the study, called the study "well designed" in its comparison of HCV patients receiving peg-IFN+RBV with HCV patients not receiving specific treatment.

He said the therapeutic message is to be aware of the possibility of the development of depression. He agreed with Dr. Pavlović in recommending against prophylactic therapy of depression and advised "very [close] monitoring because some patients are harmed...there could be some problems with suicide attempts in some patients but are very rare."

He pointed out that even patients in the control group had a high level of depression, "but it's not surprising because they have a somatic problem, and there is comorbidity [of depression] with hepatitis."

Dr. Pavlović and Dr. Pelissolo reported no relevant financial relationships.

EPA 2013: 21st European Congress of Psychiatry. Abstract 1680. Presented April 7, 2013.

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